Abstract
Patients with Mantle cell lymphoma (MCL) often present with advanced-stage and have a poor prognosis. Although MCL is highly radiosensitive, RT is rarely used other than for palliation. Stage I-II presentation is rare, and there is only limited data on treatment outcome with less aggressive combined modality approaches or RT alone. To assess the outcome of this group of patients, we retrospectively reviewed 82 patients referred to radiation oncology at 9 ILROG institutions between 1990 and 2012. Of the 82 patients, 65 (79%) were males, 44 (54%) were > 60 years; 47 (57%) were stage I, 61 (74%) presented in the head and neck areas, 51 (62%) had extranodal presentation, 14 (17%) were bulky (>5 cm). Treatment approaches consisted of combined modality (CM) with chemotherapy and consolidative radiation therapy (RT) in 66 (80%) and definitive RT alone in 16 (20%). The median radiation dose used was 35 Gy (range 12-45). Chemotherapy consisted of cyclophosphamide, adriamycin, vincristine, and prednisone (CHOP) or CHOP-like, regimens in 62 (57%), rituximab was added to chemotherapy in 51 (62%). The median follow-up was 60 months (range 5-245). At last follow up, 26 (32%) patients relapsed (70% of relapses were outside the radiation field) and 21 (26%) died (2 deaths unrelated to disease or treatment).
The 5-and 10-years overall survivals (OS) were 71% and 63%, respectively. The 5-and 10-years disease free survivals (DFS) were 75% and 39%, respectively.
On univariate analysis, the following characteristics were significantly associated with DFS and OS: age as a continuous variable (HR=1.05, p=0.005 for DFS; HR=1.05, p=0.006 for OS) and bulky disease (HR=2.78, p=0.03 for DFS; HR= 3.18, p=0.02 for OS). On multivariate analysis, both DFS and OS were significantly influenced by: age as a continuous variable (HR=2.09, p=0.03; HR=1.05, p=0.005), bulky disease (HR=2.23, p=0.05; HR=3.1, p=0.03), and female gender only affected DFS (HR=2.16, p=0.03).
| Survival | All (%) | Combined modality (%) | RT alone up-front(%) |
| 5-years OS | 71 | 68 | 92 |
| 10-years OS | 63 | 62 | 74 |
| 5-years DFS | 75 | 73 | 89 |
| 10-years DFS | 39 | 36 | 57 |
| Survival | All (%) | Combined modality (%) | RT alone up-front(%) |
| 5-years OS | 71 | 68 | 92 |
| 10-years OS | 63 | 62 | 74 |
| 5-years DFS | 75 | 73 | 89 |
| 10-years DFS | 39 | 36 | 57 |
Patients who presented with stage I-II MCL and were treated with programs that included consolidative local radiotherapy or even radiotherapy alone demonstrated favorable disease control and relatively long survival. It appears that radiotherapy as a sole modality can offer in selected patients a comparable DFS and OS to a combined modality approach.
No relevant conflicts of interest to declare.
Author notes
Asterisk with author names denotes non-ASH members.
